Use of osseocartilaginous paste graft for refinement of the nasal dorsum in rhinoplasty

Overview

When a hump is rasped rather than chiseled, the rasp produces fragments of bone, cartilage, soft tissue and blood that are normally discarded. The authors collected this material and used it as a paste graft to refine the dorsal lines in both primary and secondary rhinoplasty, then reviewed their results.

Sections of note

• Retrospective chart review of 77 patients, 2003 to 2009.
• Follow-up 22 to 40 months, median 28 months.
• Evaluation by clinical examination and digital photographs; a satisfaction questionnaire at 12 months.
• The paste combines properties of cartilage and bone and was described as clinically durable.
• Its diced form gives a texture that allows the surgeon to give the dorsum its final shape bimanually.
• The abstract reports no satisfaction scores, resorption rates or complication counts.

What it means for a patient

• Material that would otherwise be thrown away during hump removal can be reused to fill small irregularities on the bridge.
• The paste can be pressed into final shape through the skin at the end of surgery.
• Results are described qualitatively; no numbers on satisfaction, visible irregularity or revision are given in the abstract.

Why this paper matters

It is a low-cost alternative to diced cartilage in fascia for minor dorsal contouring, using tissue already generated by the operation. Objective measures and comparison with other camouflage materials are missing.

Terms

• Paste graft: a soft mixture of fine bone and cartilage fragments used to fill contour irregularities.
• Osseocartilaginous: containing both bone and cartilage.
• Rasp: a file used to reduce and smooth nasal bone.
• Osteotome: a chisel that removes the hump as one block.
• Dorsal aesthetic lines: the paired curved highlights along the bridge seen from the front.
• Bimanual molding: shaping a graft by pressing with both hands from outside the nose.